Primary Care Coding Alert

Reviewed on May 22, 2015

Private insurers may pay a quarter per pill

When your family physician (FP) gives Tylenol to a patient in his office, no HCPCS code describes the supply, right? Wrong!

 
In the September 2004 Family Practice Coding Alert  "You Be the Coder," a reader asked if a HCPCS code existed for billing office-administered Tylenol to an insurer and/or a patient. Although the coder said "No," one real-world expert proves her wrong.
 
In fact, HCPCS contains code A9150 (Non-prescription drugs) for a "nonprescription drug," such as Tylenol.  Although Medicare doesn't reimburse the supply, some payers may. "I have successfully billed A9150 to commercial insurance companies," says Kendra J. Schrader, RHIT, coding specialist in Maryville, Tenn. Medicare makes the code the patient's responsibility. 
 
Tip: Submit Tylenol and Benadryl (pill) as A9150 with a short description and a charge, such as 25 cents for each pill your FP gives. Make sure the physician documents the administration in the patient's medical record.